Building Vaccine Trust Among the General Public

Vaccine hesitancy and refusal to be vaccinated are major reasons mass vaccination strategies do not reach the intended coverage, even if adequate vaccine supply has been achieved. Public perceptions of vaccines are critical in reaching protective levels of herd immunity.

In this exclusive MedPage Today video, Gregory A. Poland, MD, director of the Mayo Clinic’s Vaccine Research Group in Rochester, Minnesota, discusses what it takes to build trust in a society that “no longer shares a single transcendent reference point for decision-making.”

Following is a transcript of his remarks:

Study after study shows that patients trust their individual healthcare provider, but they don’t trust big medicine, big science, the government, pharma. Why should they?

I mean, one of the things we have to say here is that it takes a long, long time to build enduring trust. It takes a few minutes to destroy it. And there are ample instances where I personally think the performance sometimes of these entities has not been of the highest caliber, and that’s a problem.

The bigger problem, I think, is the amount of mis- and dis-information and the surprising susceptibility of the population to this. I mean, we’ve always realized that the public is not very scientifically literate; they are, for the most part, innumerate — that is, they can’t manipulate probability and statistics. And unfortunately, that’s the language that healthcare providers tend to communicate in. And the tremendous onslaught of, as I call it, disinformation marketing — oftentimes those individuals have economic gain from that, whether it be visibility on social media or a product they’re peddling, whatever it would be.

And it’s been a surprising thing. I mean, rare is the patient that I’ve ever had who sees me because they have a symptom, and they’re afraid they have cancer, and they come in to see me and they completely trust me. What makes me untrustworthy 30 seconds later when we talk about COVID? Here, we enter into a realm that is not rational. And public health, government, physicians, want to address this in a rational manner. Well, how do you address an irrationality with rationality?

And I’ve argued for years that what you have to do is what their side does. You have to present the same emotional data. You have to frame this in ways that make sense to people who engage in conspiratorial thinking or heuristic thinking.

COVID has not caused these things. COVID has uncovered these things. We live in a society that no longer shares a single transcendent reference point for decision-making. Not one do we have consensus on. We are a pathologically narcissistic culture: “I will do what’s best for me, and the rest of you are on your own.” We are a scientifically illiterate culture, and we suffer under the false presupposition of the democratization of expertise.

I had a person stop me while I was out on a walk with my wife. He knew me and he knew what I did. He asked me a question about COVID and then engaged me in arguing about it. And I said to the guy, I’ll just call him John. I’ll say, well, John, I know you’ve had a lot of trouble with the electronic transmission of your Audi. What did your grocery store clerk think you should do? And he said, well, how would she know anything about …? And he stopped himself and he got the point: Why would you look to a celebrity, or an athlete, or a rap singer, whatever it would be, for your information on something that affects your life, your family’s life, and the community around you?

Everybody wants a quick fix. Here’s the real answer. You start with people who don’t make decisions about vaccines. You start in the grade schools and you educate about the scientific method, about the value of vaccines, how to make decisions, how to be discerning.

If you say, well, what can physicians do now? My daughter and I [and Tamar Ratishvili] published a paper called The Empathy Tool [“Vaccine Hesitancy and Health Care Providers: Using the Preferred Cognitive Styles and Decision-Making Model and Empathy Tool to Make Progress”]. It’s a tool that physicians can use right now for beginning what we call the journey from rejection and hesitancy to understanding and acceptance.